Pediatric Hematology/Oncology and ImmunopathologyPediatric Hematology/Oncology and ImmunopathologyВопросы гематологии/онкологии и иммунопатологии в педиатрии1726-17082414-9314Fund Doctors, Innovations, Science for Children27110.24287/1726-1708-2019-18-3-145-153LITERATURE REVIEWОБЗОР ЛИТЕРАТУРЫRelevance and management of secondary hypogammaglobulinema in clinical practiceАктуальность и методы коррекции вторичной гипогаммаглобулинемии в клинической практикеhttps://orcid.org/0000-0003-2689-0569BalashovD. N.БалашовД. Н.
Russian Federation

Dmitri N. Balashov, PhD, Head of Hematopoietic Stem Cell Transplantation Department № 2,

117997, Moscow, Samory Mashela st., 1

Балашов Дмитрий Николаевич, доктор медицинских наук, заведующий отделением трансплантации гемопоэтических стволовых клеток № 2, врач-гематолог

117997, Москва, ГСП-7, ул. Саморы Машела, 1

bala8@yandex.ruDmitriy Rogachev National Medical Research Center of Pediatric Hematology, Oncology, Immunology Ministry of Healthcare of Russian FederationФГБУ «Национальный медицинский исследовательский центр детской гематологии, онкологии и иммунологии им. Дмитрия Рогачева» Минздрава России130920191831451531309201913092019Copyright ©; 2019, «D. Rogachev NMRCPHOI»Copyright ©; 2019, ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава России2019«D. Rogachev NMRCPHOI»ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава Россииhttps://creativecommons.org/licenses/by/4.0https://hemoncim.com/jour/article/view/271

Advance protocols for the treatment most of oncology, hematology and some inherited disorders may lead to development severe secondary hypogammaglobulinaemia. Particularly, it is often caused by therapy with monoclonal antibodies binding B-cells (such as rituximab, belimumab, inotuzumab), therapy with inhibitors of tyrosine-kinase (imatinib, desatinib), as well as applying a variety of immunosuppressive and chemotherapy agents (steroids, azathioprine, cyclophosphamide etc.). It should be note, that chronic lymphoid leukemia and multiple myeloma could be complicated with hypogammaglobulinaemia, not only because of specific therapy, but also as features of the diseases. Hematopoietic stems cells transplantation can also lead to development severe and prolonged hypogammaglobulinaemia. This is associated with intensive immune/myeloablative therapy, as well as with immunologic reconstitution after transplantation. Modern intravenous immunoglobulins (IVIG) have a wide repertoire of pathogen-specific activity with high safety profile and constitute essential part of therapy patients with secondary hypogammaglobulinaemia. The paper presents literature review of IVIG usage in various clinical situations, as well as several clinical examples of personal experience.

Современные протоколы терапии многих онкологический, гематологических и некоторых наследственных заболеваний могут приводить к развитию тяжелой вторичной гипогаммаглобулинемии. В частности, причиной ее нередко становятся терапия моноклональными антителами к В-клеткам (ритуксимаб, белимумаб, инотузумаб) и ингибиторами тирозинкиназ (иматиниб, дезатиниб), а также применение целого ряда иммуносупрессивных и химиотерапевтических агентов (глюкокортикостероидов, азатиаприна, циклофосфамида и др.). При хроническом лимфолейкозе и множественной миеломе причиной гипогаммаглобулинемии может быть не только специфическая терапия, но и некоторые особенности самих заболеваний. Трансплантация гемопоэтических стволовых клеток также приводит к развитию тяжелой и длительной гипогаммаглобулинемии. Это ассоциировано как с проводимой интенсивной иммуно-/миелоаблативной терапией, так и с особенностями иммунологической реконституции после проведенного лечения. Современные препараты внутривенных иммуноглобулинов (ВВИГ) обладают широким репертуаром патоген-специфической активности при достаточно высоком профиле безопасности и являются неотъемлемой частью сопроводительной терапии пациентов с вторичной гипогаммаглобулинемией. В работе представлен обзор литературных данных о применении ВВИГ в различных клинических ситуациях,  а также несколько клинических примеров из собственного опыта.

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